Organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Parent organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Other names
College of Applied Health Sciences Faculty Practice
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Authorized official
MARY THERESE KEEHN PT (ASSOC DEAN FOR CLINICAL AFFAIRS)
(312) 413-2873
Entity
Organization
Contact information
Practice address
1640 W ROOSEVELT RD, CHICAGO, IL 60608-1336
(312) 996-6695
(312) 413-0086
Mailing address
808 S WOOD ST STE 169, CHICAGO, IL 60612-7306
(312) 996-6695
(312) 413-0086
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103K00000X
Behavior Analyst
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
222Q00000X
Developmental Therapist
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Enumeration date
07/06/2006
Last updated
06/17/2026
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